| NPI | 1629326400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NV S6-120) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 61687) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: NM DB-2026-0143) | |
| Enumeration Date | 2012-08-27 |
| Last Update Date | 2026-06-08 |